Juvenile idiopathic arthritis – implications on facial growth and contemporary management

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis that affects children, with a reported prevalence rate of 0.07–4.01 per 1000 children. The annual incidence is reported as 0.008–0.226 per 1000 children.¹ Previous published literature discusses the effects and morbidity of JIA but its effects on facial structures and oral function is poorly understood.

The precise aetiological factors are not known yet, however, many factors can be implicated separately or concurrently, such as auto-immunological factors, viral infections, traumatic episodes, psychological factors and genetic factors.²

There are seven main types of JIA, as specified by Petty et al:³

Oligoarthritis, the most prevalent form of JIA, is defined as arthritis affecting 1–4 joints during the first 6 months of disease. Two subcategories are recognized:

The implications of JIA on extra-oral and intra-oral features are not noticeable if the TMJs are not affected. Arvidsson et al⁵ showed that 70% of patients with JIA and TMJ involvement had some form of craniofacial growth disturbance. Pedersen et al described facial asymmetries as a common presenting feature in patients diagnosed with this condition, secondary to an unequal rate of condylar destruction or unilateral activity⁶